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www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 13 - Nº 3, 2018

Design and Psychometrics of Tool of Health Needs in Patients with Chronic Back Ache

Diseño y psicometría de la herramienta de medición de las necesidades de salud en pacientes con dolor de espalda crónico 277 Khatereh Rostami1, Farkhondeh Sharif2, Ladan Zarshenas3*, Abbass Ebadi4, Arash Farbood5 1Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. 2Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 4Behavioral Sciences Research Center, Instituto de estilo de vida, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. 5Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. *Corresponding author: Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Postal cod: 7193613119, Tell l: + 987136474251, Fax: +987136474252, E mail: [email protected] Abstract he necessity of valid, reliable and objective tools chronic back ache were explained in four dimensions: ed- is one of the subjects that have always been ucation and information needs, spiritual / religious needs, emphasized in studies related to the health of socio-economic needs, and physical-psychological needs. individuals. However, it is believed that existing tools gen- Based on these four dimensions, 109 original items were erally do not have the necessary credibility and designed. 91 items in the Item Impact section acquired and cannot correctly assess the health needs of patients the scores 1/5 and higher. In terms of content validity, 49 with chronic back ache. This study aimed to design a valid items received 0.49 and higher. The content validity index and reliable tool for assessing the health needs of patients of the individual items was equal to one, and the content with chronic back ache. validity index of the entire tool, both as S-CVI / Universal and as S-CVI / Average, was 1 at this stage. The kappa This is an exploratory sequential mixed (qualitative-quan- coefficient of all the terms was equal to one. titative) method research conducted in medical sciences clinics of the Ministry of Health and Medical Education in In this structure, using exploratory , four Shiraz in 2017. In the qualitative phase factors were also explained; they were named based on through with patients, their family carers, the the items of each group. The internal consistency of the treatment team in relation to these patients, the health tool by calculating the total Cronbach’s alpha coefficient needs of patients with chronic back ache were defined was 0.75, which was 0.73 in education and 0.72 in so- and then, based on the findings and with extensive re- cial/economic needs, 0.74 in physical needs and 0.72 in view of the texts, the tool’s dimensions and items were psychological needs. The intra-cluster correlation was designed. Then, in the quantitative phase of the psycho- equal to … metrics of tool, the content (quantitative and qualitative) validity and structural validity (factor analysis) were done The designed tool for the needs of chronic back ache pa- by using different methods of formal (quantitative and tients has different dimensions and has a good validity and qualitative) validity. was also calculated through reliability. This tool can provide an appropriate assessment internal consistency and stability. of the health needs of patients with chronic back ache and improve the of services provided to patients. 29 people are the participants included patients with chronic back ache, family carers and specialists associ- Keywords: Health Needs, Patients, Chronic Back Ache, ated with the disease. The health needs of patients with siones y tiene una buena validez y confiabilidad. Esta he- rramienta puede proporcionar una evaluación adecuada de las necesidades de salud de los pacientes con dolor de espalda crónico y mejorar la calidad de los servicios pres-

Resumen tados a los pacientes. a necesidad de herramientas válidas, con- Palabras clave: Necesidades de salud, pacientes, dolor fiables y objetivas es uno de los temas que de espalda crónico, cuestionario siempre se han enfatizado en estudios relacio- nados con la salud de las personas. Sin embargo, se cree que las herramientas existentes generalmente no tienen la credibilidad y validez necesarias y no pueden evaluar co- rrectamente las necesidades de salud de los pacientes con dolor de espalda crónico. Este estudio tuvo como objetivo 278 diseñar una herramienta válida y confiable para evaluar las necesidades de salud de los pacientes con dolor de espalda crónico. hronic pain is one of the most common Se trata de una investigación exploratoria secuencial mixta Introduction problems affecting the lives of individuals (cualitativo-cuantitativa) realizada en las clínicas de cien- and societies1. Chronic back ache is one of cias médicas del Ministerio de Salud y Educación Médica the most common types of chronic pains and musculo- en Shiraz en 2017. En la fase de análisis de contenido skeletal disorders, and 70-80% of people experience it at cualitativo a través de entrevistas con pacientes, sus fa- least one time during their life. Most patients with acute miliares cuidadores, el equipo de tratamiento en relación back ache recover within 6 weeks, and only 10-25% of con estos pacientes, se definieron las necesidades de sa- the remaining patients are at risk for chronic back ache2,3. lud de los pacientes con dolor de espalda crónico y luego, en base a los hallazgos y con una extensa revisión de los Several studies have shown evidence of an increase in the textos, se diseñaron las dimensiones y los ítems de la he- incidence of chronic back ache and resulting disabilities rramienta. Luego, en la fase cuantitativa de la psicometría worldwide4-7. The incidence of back ache has increased in de la herramienta, la validez del contenido (cuantitativo Americans so that it causes significant financial, personal y cualitativo) y la validez estructural (análisis factorial) se and social losses, and in addition to disability it leads to realizaron utilizando diferentes métodos de validez for- high cost of treatment8-10. In Iran is also back ache with mal (cuantitativa y cualitativa). La confiabilidad también a prevalence of 27.18% and working people with back se calculó mediante consistencia interna y estabilidad. ache have more anxiety, depression and psychological dis- 29 personas son los participantes incluidos los pacientes orders11. Patients with chronic back ache have their own con dolor de espalda crónico, cuidadores familiares y es- specific needs. Fast tiredness in the muscles of the spinal pecialistas asociados con la enfermedad. Las necesidades column and the abdominal muscles during daily activi- de salud de los pacientes con dolor de espalda crónico se ties has caused the problems of this group of patients to explicaron en cuatro dimensiones: necesidades de educa- be distinguished from other people with musculoskeletal ción e información, necesidades espirituales / religiosas, system problems12. In most cases, back pain is removed necesidades socioeconómicas y necesidades físico-psico- after a few weeks, but in some cases it remains for a long lógicas. En base a estas cuatro dimensiones, se diseñaron time and causes many problems and needs for those who 109 artículos originales. 91 artículos en la sección Impacto suffer from it. Therefore, due to the inevitability of these del artículo adquirieron los puntajes 1/5 y superiores. En needs and given the affectability of the needs from the términos de validez de contenido, 49 artículos recibieron cultural context of a society and the need for a deep look 0.49 y más. El índice de validez de contenido de los ele- at this category, it seems necessary to determine the di- mentos individuales era igual a uno, y el índice de vali- mensions of the health needs of patients with chronic dez de contenido de toda la herramienta, tanto S-CVI / back ache and make a tool that meets the needs of these Universal como S-CVI / Promedio, era 1 en esta etapa. El patients, appropriate to Iranian texture and culture. Also coeficiente kappa de todos los términos fue igual a uno. a reliable and valid tool for assessing the health needs of En esta estructura, utilizando el análisis factorial explora- patients with chronic back ache allows specialized groups torio, también se explicaron cuatro factores; fueron nom- to easily use their specialized tools. Therefore, the present brados en base a los artículos de cada grupo. La consis- study was conducted with the aim of designing and psy- tencia interna de la herramienta al calcular el coeficiente chometric of the health needs of patients with alfa total de Cronbach fue de 0,75, que fue de 0,73 en chronic back ache in Iran. educación y 0,72 en necesidades sociales / económicas, Procedure: The present research is an exploratory sequen- 0,74 en necesidades físicas y 0,72 en necesidades psicoló- tial (quantitative-qualitative) combination study. is gicas. La correlación intra-cluster fue igual a ... collected, analyzed, and integrated with two qualitative La herramienta diseñada para las necesidades de pacien- and quantitative approaches. This study has been de- tes con dolor de espalda crónico tiene diferentes dimen- signed in two stages: 1. Qualitative content analysis to www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 13 - Nº 3, 2018 determine the classes and themes. 2. Design and psycho- In this way, for each tool item, the 5-part Likert of metric evaluation of the health needs of patients with it is quite important (5 points), it is partly important (4 chronic back ache. In this method, first, the concept is points), it is on average important (3 points), It is a little explained, then the items of the tool are formed and fi- important (2 points), and it does not matter at all (1 point) nally the validity and reliability of the tool are examined13. was considered. Then, 18 patients with chronic back ache This study was conducted in 2012 in health clinics affili- identified the importance of each item. The score of the ated with the Ministry of Health and Medical Education effect of each item was calculated according to formula 1. of Shiraz. In the item impact method if the score of the effect is equal to or greater than 1.5, then that item will be retained16. The present research was conducted to design a tool for evaluating the health needs of patients with chronic back Formula 1: The impact score of the item: Importance × ache. As a first step in this process, semi-structured in- (by percent) = Impact score terviews were conducted in the form of content analysis approach with patients with chronic back ache and their - Content validity is how much a tool contains appropriate family carers as well as various specialists in relation to items for a measured structure and properly covers the 279 these patients. In this process, according to the purpose area of the structure. Content validity is based on experts’ of the research, was done to define the judgment. Qualitative and quantitative methods were health needs of patients with chronic back ache and to used to determine the content validity. In qualitative inves- determine the dimensions and its items. Then, by review- tigation of content validity, 15 individuals were asked to ing the studies, the articles related to instrumentation and express their views on grammar, the use of proper words 13 also the need-assessment tools of the patients were ex- and the placement of items in their place . To verify the amined. The stages are as follows: validity of the content Quantitatively, two methods of Content Validity Ratio (CVR) and Content Validity Index First stage: First, the health needs of patients with chronic (CVI) were used. First, to determine the content validity back ache were explained based on the views of patients ratio, the experts were asked to examine each item based with chronic back ache and their family carers and spe- on the 3-part (it is necessary, it is useful but cialists. Dimensions of tool and items related to each di- not necessary, it is not necessary). Then, responses were mension were determined based on the views of patients calculated according to formula 2 (17 and 18) based on with chronic back ache and their family carers, different the Lawshe table and the number of experts of the items specialists and review of the texts. Determining the do- whose content validity ratio was higher than 0.49 was re- main and scope of the concept is one of the first steps in tained19. designing the tool. This can be achieved through a review of studies and interviews with experts, as the appropriate Formula 2: methods for determining the scope and concept14. In order to evaluate the content validity index, Waltz & After defining the health needs of patients with chronic Bausell’s method was used. To this end, the tool was pro- back ache and determination of dimensions and items of vided to 15 experts and they were asked to determine the desired tool, information gathered was examined by the relevance, clarity and simplicity of each item in the tool research team during meetings. Some items have been in- from a score of 1 to 4 based on the content validity index tegrated or deleted, and some have changed. In this way, of Waltz and Bausell13. The score of content validity index the primary tool for evaluating the health needs of pa- of each item was calculated by the percentage of scores tients with chronic back ache was designed with a 5-part of I agree for each item that received scores 3 and 4 in the Likert spectrum (I fully agree, I agree, I neither agree nor area of “relevance” based on formula 3. disagree, I disagree, and I completely disagree). Second stage: After the design of the primary tool, its psychomet- Formula 3: ric steps began. In the present research, face validity, con- tent validity, and structure validity were used to validation of the tool. The internal consistency and stability method was used to determine the reliability. The validity of a tool Due to the possibility of a chance agreement in the Con- determines how much a tool measures what it should be tent Validity Index, Cohen’s modified Kappa coefficient measured. In face validity, the purpose is to determine was also calculated for the items. The Kappa coefficient whether the tool has a suitable form for measuring the represents an index of the agreement among the evalua- 15 structure . For qualitative and quantitative methods were tors on the relevance of the item. The Kappa coefficient used for determination of face validity. In the qualitative was calculated based on formula 4. Kapa coefficient method of face validity, 12 people of the nursing experts above 0.75 is considered excellent, between 0.6-0.74 examined the tool in terms of appropriateness and appro- good and less than 0.59 weak20. priate relation of the items with the dimensions of the tool Formula 4: and the existence of the word reflecting the concept. To determine the face validity quantitatively, the importance of each item was investigated with Item Impact Method. Then, based on the scores of the content validity index of all tool items, the mean content validity index of the tool was calculated. In this method, items with a score higher than 0.79 are appropriate, those between Results 0.79 to 0.7 need to be corrected and those less than 0.7 are unacceptable20. he purpose of this research was to design and psychometric assessment of a valid and reliable Several methods are available to achieve structure validity. tool for evaluating the health needs of patients In this study, exploratory factor analysis has been used as with chronic back ache. The results of this research are a common method for determining the validity of the presented in two quantitative and qualitative parts. health needs questionnaire for patients with chronic back ache. Factor analysis is used to construct a to Qualitative Part help determine the homogeneity of selected questions, The qualitative part included the explanation of the health namely, the existence of a key factor and the choice of needs of patients with chronic back ache and the dimen- 280 homogeneous questions. By choosing questions with a sions and items of the tool based on the opinion of pa- certain factor weight, a form of content validity tients and specialists on chronic back ache and review of can be obtained22. the texts. The definition of the health needs of patients with chronic back ache from the viewpoint of patients, their family carers and specialists in the field of back pain was stated as follows: The health needs of patients with chronic back ache include needs in four areas: the need for education and information, spiritual / religious needs, Socio-economic needs and physical-psychological needs.

Determining the dimensions and items of the tool and designing it: the initial tool consists of 4 dimensions and 109 items with 5-option Likert spectrum (I fully agree: 5, he reliability of the research tool shows that the

Methods & Reliability I agree: 4, I neither agree nor disagree: 3, I disagree: 2, I use of this tool in repeated in totally disagree: 1). the same conditions gives the same results in 13 the same way . The reliability is related to the correctness Quantitative Part: validation of questionnaire of one tool. The tool is reliable when it reflects the cor- Face validity: Face validity was evaluated qualitatively and 22 rect and error-free scores . To calculate the reliability, the quantitatively. In the qualitative study of face value, the 21 number of samples between 30-50 is appropriate . The items were examined in terms of “difficulty of the expres- reliability coefficient of 0.7 or higher indicates an accept- sions”, “degree of fit and relevance of the expressions able level of reliability (14 and 20). In order to measure with the main purpose” and “existence of ambiguity the reliability of the tool, internal consistency and reli- and insufficiency in the of words”. The neces- ability were used in this study. In this research, internal sary corrections were made based on the comments of consistency was assessed by calculating the Cronbach’s 12 experts. A total of 18 items have been modified and 14 alpha coefficient . For this purpose, 400 patients were 18 items were removed due to their alignment with other evaluated by the researcher and the tool for measuring items. At this stage, the number of questions fell to 91. the health needs of patients with chronic back ache was completed for them. Then Cronbach’s alpha was calculat- In the quantitative study of face validity, the score of Item ed for the tool in general and each dimension separately. Impact was estimated by 18 patients with chronic back In order to determine the stability of the questionnaire, ache in which 25 items scored less than 1.5. Thus, the the test method of retest was used with a 2-week inter- items were reduced to 66 ones. Content validity: it was val. The questionnaire was completed in 2-week interval also evaluated qualitatively and quantitatively. by 50 patients with chronic back ache. Then, using the Content validity was evaluated in qualitative terms based obtained scores in these two stages, the inter-cluster cor- on the views of 15 people who knew about grammar, the relation coefficient was calculated. The most acceptable use of proper words and the positioning of items in their statistical test for evaluating the reliability (stability) is the place, 19 of which had editorial changes. intra-cluster correlation index. If the index is between 0 and 0.2, it is considered to be of low stability, if it is be- In studying the validity, quantitatively, 15 experts in the tween 0.21 and 0.4, it is weak, if it is between 0.41 and field of back pain, nursing and instrumentation were 0.6 is moderate, between 0.61 and 0.8 it is good and if it asked to comment on the necessity of each item in a is higher than 0.8, the degree of stability is considered to three-part spectrum, useful, but not necessary, and not be excellent23. necessity. The content validity ratio was calculated based on the Lawshe table. At this stage, based on the Law- she table and the minimum score of 0.49, 17 items were eliminated and the items dropped from 66 to 49. www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 13 - Nº 3, 2018

Content validity index was also calculated. In order to Figure 1: to determine the number of factors calculate the CVI, the three criteria of “relevance”, “sim- in the questionnaire plicity” and “clarity” of the questionnaire were separately examined by 15 experts and scholars in a four-part Lik- ert spectrum for each item. In this stage, 9 items have changed in terms of “simplicity” and “clarity” and one question has also been divided into two parts. So the number of questions ranged from 49 to 50. In terms of “relevance” all items have a content validity index of 1 that is acceptable. In the next step, the Kappa coefficient was calculated. In this stage, the Kappa coefficient for each single item is equal to 1, which is classified as excel- lent. So none of the items were removed. S-CVI / AVE and S-CVI / UA were calculated, which were both equal to 281 one. In the next stage, structure validity was investigated The four main factors of the questionnaire of health needs through exploratory factor analysis. The factor analysis is of patients with chronic back ache explain 64.41% of the combined of a number of statistical techniques and aims total . In other words, the factor analysis revealed to simplify complex data sets. In the present study, the 4 Eigenvalues over one, which, in total, explained 64.41 ratio of 8 to 1 of subjects to variables was used. Therefore, % of variance, as shown in [Table 1]. being questionnaire composed of 50 items, the Table 1: Eigenvalues of each factor and variance explained size was determined as to be 400 people. by each post-period factor Rotation Squared Factor Initial Eigenvalues of Prior to factor analysis, items that had a correlation of Sums Loadings less than 0.5 were eliminated based on the Anti-image % of Cumulative % of Cumulative Total Total table. In this study, 19 items were removed before the Variance % Variance % start of the next stage due to a correlation of less than 1 98/11 43/37 43/37 78/7 34/24 34/24 2 76/3 77/11 21/49 99/4 50/15 84/39 0.5. There are powerful data in factor analysis when items 3 62/2 20/8 24/57 72/4 77/14 62/54 are loaded uniformly and over 0.5 in the factors. In other 4 23/2 99/6 41/64 13/3 79/9 41/64 words, if the Extraction column shows a numeric value Subsequently, the extraction of the factors was done by of less than 0.5, then the component should be removed main component analysis method using varimax rotation. 24 from the analysis . At this point, 2 items were dropped In this study, for the analysis of the main components, fac- out due to the item being less than 0.5. So the number tor coefficients (or factor load) of 0.4 were considered as of items reached 29. Adequacy was then stud- the minimum factor load needed to maintain each expres- ied by measuring the Kaiser-Meyer-Olkin (KMO) sampling sion in the extracted factors. The preliminary results of prin- adequacy scale. According to Cereny & Kaiser, the Kies- cipal component analysis showed that none of the items er-Mayer-Oleckin value should be greater than 0.6 to be had a factor loading of less than 0.4, and therefore they 26 able to do a factor analysis . At this stage, the sampling were not removed. After analyzing the main components adequacy obtained from the Kaiser-Mayer-Olekin with Varimax rotation, four main factors were extracted was equal to 0.807 which was accepted and confirmed. In based on the eigenvalues. In this stage, four factors of the next stage, to ensure that the matrix of data correla- education and information, socioeconomic needs, physical tion in population is not zero and there is enough correla- well-being and needs were recorded. tion between the items of the questionnaire, the Bartlett’s test was used25. The results of this test were significant at Reliability of the tool: Internal consistency and stability the level of 0.001, which indicates the acceptable perfor- were used to examine the reliability. In the study of inter- mance of factor analysis with respect to the correlation nal consistency, Cronbach’s alpha coefficients were calcu- matrix obtained in the sample. In the next stage, in order lated first. The Cronbach’s alpha coefficient of the ques- to extract the factors from the main component analysis tionnaire was 0.75 which has good reliability. The number method and to determine whether the sum of questions of items in each dimension and the alpha coefficient of was saturated with several factors, three important indi- each dimension have been shown in [Table 2]. ces of​​ eigenvalues (Kaiser standard), the ratio of variance explained by Each factor and diagram of Eigenvalues or​​ Table 2: Cronbach’s alpha of subscales and the entire health Scree plot were used. In diagram 1, Scree plot was ob- needs questionnaire for patients with chronic back ache served; four factors were sufficient to explain the num- Factor Subscale Items Cronbach’s alpha Education & ber of factors in the health needs of patients with chronic 1 10 0.73 information back ache. Social/economic 2 4 0.72 needs 3 Physical needs 4 0.74 4 Psychological needs 11 0.72 Entire Questionnaire 29 0.75 Also, in order to calculate the internal consistency, in ad- dition to calculating the Cronbach’s alpha coefficient, a split-half technique was used. To calculate the internal consistency by this method, the questions of a test were divided into two even and odd halves, and then the cor-

relation between the scores of the two halves was exam- Discussion n this study, a valid and reliable tool for assessing ined. The correlation results between the even and odd the health needs of patients with chronic back ache questions have been presented in [Table 3]. was designed with necessary and objective details and in complete sentences, for behavioral purposes. This Table 3: of even and odd questions tool is a tool that can assess the different needs of patients Questions Odd questions Even questions p-value with chronic back ache in various clinics. For this purpose, Odd r=1 r=+0.83 0.001 an exploratory sequential mixed method research tool was even r=+0.83 r=1 0.001 developed consisting of 4 domains and 29 items. For the 282 As shown in this table, the correlation coefficient of even designed tool, a 5-part Likert spectrum was considered. questions and odd questions is +0.83, which indicates a This was done in order to more objectively assess how good and positive relationship between questions, and to score and assign scores in a more accurate way. The the good internal consistency of the tool. designed tool includes education and information dimen- sions, socio-economic needs, physical needs and psycho- In the stability study, the total coef- logical needs, which are important aspects of the health ficient between these two tests is at significant level of needs of patients with chronic back ache. p <0.001 equal to 0.988, and the correlation coefficient of all subscales is above 0.8, which is significant and ex- Lowliss (1989) designed the Dallas Pain Questionnaire to cellent. As a result, the stability of this questionnaire has investigate the effect of spinal pain on patient behavior. been proven. [Table 4] shows the intra-cluster correlation He used factor analysis to verify the structure validity and of the sub-scales and the total tool between the two tests. finally the two factors were finally stabilized. Also, conver- gent validity was evaluated through correlation analysis Table 4: Intra-cluster correlation between scores of sub- with McGill’s Pain Questionnaire. The results showed that scales and total questionnaire of two tests these two had a positive correlation with Confidence each other. Validity was also evaluated through a review Factor Subscale ICC level of ICC p-value of known groups of people with spinal pain and healthy (0.95) subjects. The results show a significant difference in the 1 Education & information 989/0 0.0-976.995 001/0>p scores of these two groups. In evaluating this question- 2 Social/economic needs 923/0 0.0-836.964 001/0>p naire, only the validity of the structure has been inves- 3 Physical needs 965/0 0.0-879.986 001/0>p tigated and other validities whose check is the require- 4 Psychological needs 995/0 0.0-990.998 001/0>p ments of a standard tool have not been evaluated. The reliability of the questionnaire was also examined through entire questionnaire 988/0 0.0-972.994 001/0>p a re-test. The correlation score between these two tests Scoring: In order to have a better of the is 0.97, which indicates the good reliability of this tool. scoring and comparability of the subscales of the ques- Here, other methods of reliability such as Cronbach’s al- 26 tionnaire, a linear transformation formula was used. pha have not been used . (Formula No. 5) First, in order to calculate the scores of Anagnostis (2004) evaluated the psychometrics of Pain each class, the maximum and minimum difference of Inability Inventory. In this questionnaire, the reliability of scores was divided by 3 to be specified the size of the the questionnaire was investigated using retest method. classes, which was equal to 38.6. Then to the minimum The correlation was equal to 0.97. Also, internal reliability score (score 29) this value was added to be formed class- was investigated with Cronbach’s alpha, being equal to es. Therefore, the raw score represents 29-67.69 as the 0.96. Validity of this questionnaire was evaluated through low need class, 67.70-106.39 as the moderate need class structure validity. Convergent validity was assessed and 106.40-145 as high need class. The total score of the through studying its correlation with Oswestry question- questionnaire is interpreted in a three-part Likert of low naire of the visual analogue Scale, which had a significant need, moderate need, and intense need. relationship with each other. Factor analysis was used in Formula 5: 100 × (earned raw score-total minimum score) studying structure validity. Two main factors covered the / (total minimum score-total maximum score) whole questions. After determining the specific value fac- tors, factors above 1 were reported. Factor 1 has a specific value of 7.46 and accounts for 49.7% of the variance. Factor 2 also has a special value of 1.3 and explains 8.6% of the variance. In this study, other methods of determin- ing the validity of content such as content validity, which is one of the important components of validity, has not been investigated27. www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 13 - Nº 3, 2018

Kim (2005) developed the Oswestry Initial Questionnaire Conclusion: The designed tool is a tool for evaluating the in Korean language. This questionnaire provides informa- health needs of patients with chronic back ache, which tion on the inability created by spine diseases for patients. is finally prepared in 4 dimensions and 29 items. All the Structure validity was used to determine the validity of this scores calculated on the validity and reliability of the tool questionnaire. To evaluate this validity, convergent validity were appropriate. The items of this tool have been pro- was used. The correlation of this questionnaire with the vided even in detail, in objective and complete sentences questionnaire of visual analogue scale questionnaire (r = with behavioral goals, and their scoring based on the Lik- 0.425) and with the World Health Organization Quality of ert spectrum is convenient. As a result, the tool developed Life Questionnaire (r = 0.480), was reported to be of ap- in this research, with its proper characteristics, can be propriate. Also, to investigate the reliability, the retest was used to assess the health needs of patients with chronic carried out with a two-day interval. Its intra-cluster cor- back ache. relation coefficient was equal to 0.916, but a retest with a low distance can falsely increase this coefficient and Appreciation This article is based on the student’s thesis of Mrs. Khat- due to the effect, this correlation coefficient has 283 increased. Also, to assess the reliability, it evaluates the ereh Rostami, under project number 13821, which was internal stability. Cronbach’s Alpha has been reported by sponsored by the Vice-Chancellor of Research and Tech- 0.84 after two days. The results indicate good stability of nology of Shiraz University of Medical Sciences to whom the questionnaire28. In the study, only one of the methods we express our gratitude. Also, all patients, professors and of determining the validity has been investigated. While respected specialists who have been very patient in de- evaluating other validities, such as face and content valid- signing and determining the reliability and validity of the ity, is a prerequisite for psychometric requirements. tool, are sincerely appreciated.

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